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Review article: Biomedical intelligence

Vol. 142 No. 3738 (2012)

Hunger strike among detainees: guidance for good medical practice

  • Laurent Gétaz
  • Jean-Pierre Rieder
  • Laurent Nyffenegger
  • Ariel Eytan
  • Jean-Michel Gaspoz
  • Hans Wolff
Cite this as:
Swiss Med Wkly. 2012;142:w13675


Hunger strike is a regularly reported problem in prison. Although clinical situations are rarely severe, hospitalisation is often considered. In consequence, it is not only physicians working in prisons, but also hospital medical teams who face challenges related to hunger strike, involving somatic, psychological, legal and human rights aspects. Furthermore, deontological rules must be strictly respected when delivering care, particularly in prison setting.

Starvation involves metabolic changes and can cause severe, and sometimes even irreversible or fatal complications. Moreover, the phase of re-alimentation should not be trivialised, as re-feeding syndrome is a potentially fatal phenomenon. This article provides guidance for monitoring and management of patients on hunger strike.


  1. Sebo P, Guilbert P, Elger B, Bertrand D. Le jeûne de protestation: un défi inhabituel pour le médecin. Rev Med Suisse. 2004;62(2508):2485–9.
  2. Reyes H. Force-Feeding and Coercion: No Physician Complicity. Am Med Assoc J Ethics. 2007;9(10):703–8.
  3. World Medical Association (WMA). Declaration of Malta, a background paper on the ethical management of hunger strikes. World Medical Journal. 2006;52(2):36–43.
  4. Pont J, Stöver H, Wolff H. Dual Loyalty in Prison Health Care. Am J Public Health. 2012;112(3):475–80.
  5. World Medical Association (WMA), Declaration of Malta on Hunger Strikers. 1991.
  6. Crosby SS, Apovian CM, Grodin MA. Hunger strikes, force-feeding and physicians’ responsibilities. JAMA. 2007;298(5):563–6.
  7. Hayton P, Gatherer A, Fraser A. Patient or Prisoner: Does It Matter Which Ministry Is Responsible for the Health of Prisoners? Copenhagen, Denmark: World Health Organization, Regional Office for Europe; 2010.
  8. Wolff H, Gétaz L. Hunger strike and force feeding: therapeutical and ethical issues. Rev Med Suisse. 2012;8(325):182–3.
  9. Costa JP, Baka AB, Cabral Barreto I, Jungwiert K, Butkevych V, Mularoni A, et al. Affaire Nevmerjitski contre Ukraine. Cour européenne des Droits de l’Homme, Requête no 54825/00. Strasbourg 12/10/2005;
  10. Wei M, Brendel RW. Psychiatry and Hunger Strikes. Harvard Human Rights Journal. 2010;23(1):76–94.
  11. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;28(336):1495–8.
  12. Cahill GF. Survival in starvation. Am J Clin Nutr. 1998;68(1):1–2.
  13. Peel M. Hunger strikes. BMJ. 1997;315(7112):829–30.
  14. Hearing SD. Refeeding syndrome. BMJ. 2004;17(328):908–9.

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